Prospective Evaluation of a Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry System in a Hospital Clinical Microbiology Laboratory for Identification of Bacteria and Yeasts: a Bench-by-Bench Study for Assessing the Impact on Time to Identification and Cost-Effectiveness
Prospective Evaluation of a Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry System in a Hospital Clinical Microbiology Laboratory for Identification of Bacteria and Yeasts: a Bench-by-Bench Study for Assessing the Impact on Time to Identification and Cost-Effectiveness
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DOI：
10.1128/jcm.01405-12
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发表时间：
2012-10-01
影响因子：
9.4
通讯作者：
Carroll, K. C.
中科院分区：
文献类型：
--
作者：
Tan, K. E.;Ellis, B. C.;Carroll, K. C.
基质辅助激光解吸电离飞行时间质谱仪(MALDI-TOF MS)是一种准确、快速、廉价的细菌和酵母菌鉴定方法。以前的评估已经将MALDI-TOF MS方法的准确性、鉴定时间和成本与标准鉴定系统或商业面板进行了比较。在这项前瞻性研究中，我们比较了包含MALDI-TOF MS的协议(MALDI协议)和当前的标准识别协议(标准协议)，以使用基于样本的逐个工作台的方法来确定在实际实践中的性能。定量了MALDI-TOF MS作为一线鉴定方法对鉴定时间(TTI)和成本的潜在影响。MALDI方案包括辅助测试，特别是肺炎链球菌和志贺氏菌，以及重复的MALDI-TOF MS尝试的适应症，这些通常在以前的研究中没有被测量。从2214个样本中回收的952个分离物(824个细菌分离物和128个酵母菌分离物)被用MALDI方法进行了评估。与标准方案相比，MALDI方案平均提前1.45天提供身份(P<；0.001)。在我们的实验室，我们预计MALDI方案的纳入可以在12个月内减少102424美元或56.9%的鉴定试剂和劳动力成本。该模型包括MALDI-TOF MS的固定年度成本，如蛋白质标准和仪器维护的成本，以及我们实验室遇到的生物的年度流行率。该综合成本分析模型可推广到其他中、大批量实验室。
Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been found to be an accurate, rapid, and inexpensive method for the identification of bacteria and yeasts. Previous evaluations have compared the accuracy, time to identification, and costs of the MALDI-TOF MS method against standard identification systems or commercial panels. In this prospective study, we compared a protocol incorporating MALDI-TOF MS (MALDI protocol) with the current standard identification protocols (standard protocol) to determine the performance in actual practice using a specimen-based, bench-by-bench approach. The potential impact on time to identification (TTI) and costs had MALDI-TOF MS been the first-line identification method was quantitated. The MALDI protocol includes supplementary tests, notably for Streptococcus pneumoniae and Shigella, and indications for repeat MALDI-TOF MS attempts, often not measured in previous studies. A total of 952 isolates (824 bacterial isolates and 128 yeast isolates) recovered from 2,214 specimens were assessed using the MALDI protocol. Compared with standard protocols, the MALDI protocol provided identifications 1.45 days earlier on average (P < 0.001). In our laboratory, we anticipate that the incorporation of the MALDI protocol can reduce reagent and labor costs of identification by $102,424 or 56.9% within 12 months. The model included the fixed annual costs of the MALDI-TOF MS, such as the cost of protein standards and instrument maintenance, and the annual prevalence of organisms encountered in our laboratory. This comprehensive cost analysis model can be generalized to other moderate-to high-volume laboratories.